Dahlin v. Metropolitan Life Insurance

255 F. Supp. 2d 987, 2003 U.S. Dist. LEXIS 5991, 2003 WL 1836679
CourtDistrict Court, N.D. Iowa
DecidedApril 9, 2003
DocketC01-4120-MWB
StatusPublished
Cited by3 cases

This text of 255 F. Supp. 2d 987 (Dahlin v. Metropolitan Life Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dahlin v. Metropolitan Life Insurance, 255 F. Supp. 2d 987, 2003 U.S. Dist. LEXIS 5991, 2003 WL 1836679 (N.D. Iowa 2003).

Opinion

MEMORANDUM OPINION AND ORDER REGARDING PARTIES’ MOTIONS FOR SUMMARY JUDGMENT

BENNETT, Chief Judge.

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*990 I. INTRODUCTION AND BACKGROUND

A. Procedural Background

On November 29, 2001, plaintiff Barbara J. Dahlin filed a complaint against Metropolitan Life Insurance Company (“Met-Life”), to recover long-term disability (“LTD”) benefits under a employee benefits plan provided by MetLife to her former employer. On October 15, 2002, Dah-lin filed a motion for summary judgment. In her motion for summary judgment Dah-lin argues that in this case there is no genuine issue as to any material fact' that the plan administrator improperly interpreted the terms of the plan, that the plan administrator’s decision is unreasonable, and that the plan administrator’s decision is not supported by substantial evidence. (Doc. No. 18). On October 16, 2002, Met-Life filed a cross-motion for summary judgment. MetLife argues that Dahhn is unable to create a genuine issue of any material fact that the plan administrator properly interpreted the terms of the plan, that the plan administrator’s decision was reasonable, and that the plan administrator’s decision is supported by substantial evidence. (Doc. No. 19). MetLife requested oral argument on the motions. However, the court concluded that oral argument was unnecessary for the disposition of these matters because of the completeness of the record and the thoroughness of the parties’ briefs.

The court turns first to a discussion of the undisputed and disputed facts as shown by the record and the parties’ submissions, then to consideration of the standards applicable to motions for summary judgment, and, finally, to the legal analysis of whether either party is entitled to summary judgment.

B. Factual Background

The court will not attempt to provide here an exhaustive dissertation of the undisputed and disputed facts. The court will, instead, provide sufficient facts, disputed and undisputed, to put the parties’ arguments for and against summary judgment into proper context.

Plaintiff Barbara J. Dahlin was an employee of American Marketing Industries Incorporated (“AMI”). 1 MetLife’s Appendix in Support of Summary Judgment (“Defendant’s Appendix”), Doc. No. 24 at 30-31. 2 While working for AMI, Dahlin’s duties included directing, supervising, and coordinating the production of AMI’s products (sporting goods and marketing items) in an assigned area. Defendant’s Appendix, Doc. No. 24 at 32-33. As an employee of AMI, Dahlin was a participant in AMI’s employees’ benefits plan (“the Plan”). The Plan is an employee benefits plan governed by the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1001 et. seq. (“ERISA”). Plaintiff Dahlin was furnished with a copy of the summary plan description (“SPD”) which described, among other things, eligibility requirements for LTD benefits under the Plan. The SPD’s definition for “disability” or “disabled” under its LTD benefits section is as follows:

*991 DISABILITY or DISABLED: [M]eans through the Elimination Period and for the next 24 months, the Insured cannot perform the essential duties of his or her regular occupation on a full-time basis because of Sickness or Injury.
After benefits have been paid for 24 months, the Insured cannot perform the essential duties of any occupation for which he or she is reasonably fitted by training, education or experience on a full-time basis.

Defendant’s Appendix, Doc. No. 24 at 15. The SPD also provides a definition of elimination period:

ELIMINATION PERIOD: The Elimination Period is 180 days of Disability. It begins on the first day of Disability. The Insured may work full time for 14 days or less during the Elimination Period without starting a new Elimination Period. These days will not count as satisfying the Elimination Period. An Insured who works full time for more than 14 days must begin a new Elimination Period.

Defendant’s Appendix, Doc. No. 24 at 15. Further, the SPD states that LTD benefits will begin “after the end of the Elimination Period.” Id.

In March 1997, Dahlin began to experience respiratory problems apparently caused by a malfunctioning furnace unit in her home. Defendant’s Appendix, Doc. No. 24 at 66. On March 31, 1997, Dahlin was seen at the emergency room of the Hawarden Community Hospital and was diagnosed with having dyspnea. 3 Defendant’s Appendix, Doc. No. 24 at 65. Dr. L. Willekes saw Dahlin regarding Dahlin’s respiratory problems and referred Dahlin to Dr. Bacon for further diagnosis and treatment. Defendant’s Appendix, Doc. No. 24 at 66. - On April 4, 1997, Dahlin had her first appointment with Dr. Bacon for diagnosis and treatment of her respiratory problems. Dr. Bacon’s initial impression was that Dahlin “very likely [had] bron-ehospasm and hyperactive airways disease.” Defendant’s Appendix, Doc. No. 24 at 67. On April 25, 1997, Dahlin was again seen by Dr. Bacon and Dr. Bacon wrote in Dahlin’s progress report, “She does well on days she’s out of the house as well as when she is at work.” Defendant’s Appendix, Doc. No. 24 at 68. On June 10, 1997, after another visit with Dahlin, Dr. Bacon wrote in Dahlin’s progress report, “She did well during her trip to CO although.with minimal activity she did get somewhat dyspneic and hyperventilate [sic]. This was likely related to the decreased 02 concentration.” Defendant’s Appendix, Doc. No. 24 at 69. On June 16, 1997, Dahlin had a follow-up visit with Dr. Bacon. Dr. Bacon noted in Dahlin’s progress report that Dahlin was “off steroids now” and that Dahlin “does notice that when she uses inhalers that she can premedicate before exposures with a benefit.” Defendant’s Appendix, Doc. No. 24 at 69. On July 13, 1998, Dahlin was again seen by Dr. Bacon. Dr. Bacon’s report stated, “IMPRESSION: Reactive airway dysfunction syndrome under fairly good control at present. She is planning to go to Spain this fall and I think she’ll be able to do well with the trip.... We’ll see her back in late August or early September prior to leaving on her trip.” Defendant’s Appendix, Doc. No. 24 at 74. On January 16, 1998, Dr. Bacon recorded in Dahlin’s progress report, “She’s continuing] to have some difficulties particularly when she’s around perfume[,] dust & smoke.... All in all think she’s holding fairly steady.” Defendant’s Appendix, Doc. No. 24 at 70.

*992 In addition to being referred by Dr. Willekes to Dr. Bacon, Dahlin was also referred by Dr. Willekes to Dr. Ashraf Elshami for consultation and a second opinion as to whether Dahlin had dyspnea. On March 24, 1998, Dahlin was seen by Dr. Elshami at the Central Plains Clinic. Dr. Elshami’s report contained the following:

Triggers of her symptoms include fumes, perfume, flowers, and particularly cold air. She also works in a cap factory and is exposed to a lot of lint and dye....

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Bluebook (online)
255 F. Supp. 2d 987, 2003 U.S. Dist. LEXIS 5991, 2003 WL 1836679, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dahlin-v-metropolitan-life-insurance-iand-2003.